U.S. lacks bioterrorism response

BY SUSAN KIM | Baltimore, MD |
March 12, 2001

Our health system is weak and can't even deal with an influenza epidemic -- and it's much worse than it was 10 years ago.

Jonathan Tucker

The U.S. isn't ready for a bio-terrorism attack. It is so unready, officials probably wouldn't know an attack had even occurred until it was too late, said D.A. Henderson, director of the Johns Hopkins University's Center for Civilian Bio-defense Studies.

Detecting bio-terrorism is difficult because "if somebody releases the material, it's a silent affair," said Henderson.

The realization would likely hit only after ill people began streaming into emergency rooms that are unequipped to handle crowds, seeking treatment from doctors uninformed about harmful biological agents with antibiotics that are chronically in short supply.

Covert delivery of a harmful biological agent would be a "non-event" with a delayed effect, agreed Jonathan Tucker, director of the chemical and biological weapons nonproliferation program at the Monterey Institute of International Studies.

After an incubation period ranging from days to weeks, even the effect might go unnoticed. Initial symptoms of anthrax inhalation are flu-like, for example. The patient has to be treated with antibiotics within 8-48 hours or pneumonia-like symptoms develop, followed by death within several weeks.

Like so many disasters, the best way to respond to a bio-terrorist threat is to try to prevent it from happening in the first place. "We're looking to what we can learn from the standpoint of intelligence," said Henderson. "The capabilities of the FBI and CIA in the detection area have been expanded, and that is promising."

Keeping close tabs on the activities of alleged terrorists such as Osama bin Laden is a good idea, too, he said, but catching somebody preparing a bio-terrorist attack is difficult.

"It's not an easy thing to discover. With nuclear weapons, you require a large physical facility and a lot of equipment to produce them. But with biological weapons you could have it in a small room, and it doesn't require a lot of elaborate equipment specific for that purpose."

A powder or other agent may not show up in a detection device at an airport, he added.

Detection and response is so difficult that it's important that we "do what we can to get broad-based agreement among countries that bio-terrorism is a morally reprehensible thing to be engaged in," he said.

If an attack occurs, the U.S. isn't ready, he said. "Our health system is weak and can't even deal with an influenza epidemic -- and it's much worse than it was 10 years ago." He cited severe nursing shortages as well as shortages of antibiotics across the country that occur on a regular basis. "We discovered these shortages are not just one antibiotic but a whole series, not just one company but many companies in all regions of the country.

"The public health system has been very complacent," he said.

What could help? Tucker suggested training primary care physicians to think about some unconventional agents that could cause certain symptoms.

Henderson said that there are now efforts to develop stockpiles of antibiotics, and that stocks of smallpox vaccines have been put aside as well.

Money has become available from the Centers for Disease Control (CDC) for state-level participation in planning an emergency response to bio-terrorism. "State-level emergency managers have taken this quite seriously," said Henderson.

CDC is working to "improve the nation's public health system to respond to bio-terrorism," said Joe Henderson, a CDC bio-terrorism specialist said at a meeting of the State Emergency Managers Association.

Defining bio-terrorism events as "low-probability, high-consequence events," he said that state emergency managers should give serious thought to their response. "One day it might not be just another an anthrax hoax. This is a serious threat. We should put in place the right response so we can mitigate the consequences as much as possible."

CDC has developed disease-specific information to help educate both the public and frontline emergency responders, he said.

On the federal level, a bio-surveillance system sponsored by the Defense Advanced Research Projects Agency (DARPA) is on the horizon. Through a yet-to-be determined mammoth computer system, federal officials would search pharmacy, grocery store, school, civil service, hospital, veterinary, and health-related Web site databases to see if the data reveals sudden spikes of symptoms that could be the result of bio-terrorism. Any patterns or anomalies could offer reason to put healthcare practitioners or citizens on alert.

Getting the databases to talk to each other will be a systems information challenge, and DARPA isn't yet offering a tentative solution -- or a way to ward off potential privacy problems. DARPA is asking for formal proposals from industry and universities and will select a contractor within the next year.

Henderson, Tucker, and other experts plan to continue their research, trying to make the public aware of potential dangers without panicking people. "There has been a lot of hype about bio-terrorism," said Tucker. "So on one hand, people think it's just that -- a lot of hype -- and they don't have to worry about it. On the other hand, the hype makes a lot of crazies come out of the woodwork and start making threats."

Henderson added that, while he commends what seems to be a growing awareness response officials, "a good bit more concerted thinking and planning needs to be done. We don't have a national plan."